Healthcare Provider Details

I. General information

NPI: 1861519159
Provider Name (Legal Business Name): PUCKETTE CHIROPRACTIC & KINESIOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 EXCELSIOR DR STE 300
MADISON WI
53717-2910
US

IV. Provider business mailing address

822 E WASHINGTON AVE APT 730
MADISON WI
53703-6508
US

V. Phone/Fax

Practice location:
  • Phone: 608-276-7635
  • Fax: 608-276-7728
Mailing address:
  • Phone: 608-276-7635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3198
License Number StateWI

VIII. Authorized Official

Name: DR. STEVEN R. PUCKETTE
Title or Position: OWNER
Credential: D. C.
Phone: 608-276-7635